Browsing by Author "Ross, Sarah"
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Item Advance Care Planning(2021) Ross, Sarah; Vu, Katie; Ahmed, MaheenAdvance care planning (ACP) is the process of communicating with patients and their families about the type of healthcare the patient wishes to receive. The Merit-based Incentive Payment System (MIPS) has ACP as a measure, communicating to providers the value of having ACP discussions with older adults. ACP provides an opportunity for patients to communicate what is most important to them for end-of-life healthcare. Each HSC Health provider is a Merit-based Incentive Payment System (MIPS) eligible clinician. The MIPS measure for ACP is assessed over a calendar year (from January 1st to December 31st). In September 2019, an online learning module educating providers on the basics of Advance Care Planning was made available for the HSC Clinical Practice Group. In this research project, we evaluate the effect of the online ACP module on primary care providers (Family Medicine and Geriatrics) performing and documenting advance care planning. Data from January 1, 2019 to December 31, 2020 was extracted, and descriptive statistics used to compare overall performance rates between 2019 and 2020. Results indicate that from 2019 to 2020 providers in Geriatrics and Family Medicine collectively improved in documenting that ACP was reviewed. Providing education on the importance of ACP and how to perform an ACP visit is one of the interventions that has promoted improvement in the overall practice performance on the MIPS measure of ACP from 2019 to 2020.Item Assessing Cognitive Function: The Role of the Memory Alteration Test in Predicting Stroop Color-Word Performance within the Self-Management Program for Brain Health(2024-03-21) Aboutaj, Amin; Ross, Sarah; Soto, Isabel; Severance, JenniferPurpose: The Self-Management Program for Brain Health is designed to empower participants to make lifestyle changes that enhance cognitive function and potentially delay dementia onset. This study investigates the predictive relationship between the Memory Alteration test and Stroop Color-Word (Stroop CW) performance in these participants, aiming to contribute valuable insights to the complex interplay between memory and executive processing abilities. Methods: Cognitively healthy adults (n = 21, age range 56–90) participated in the study, meeting inclusion criteria and undergoing vital sign assessment, Memory Alteration, and Stroop CW tests. The Memory Alteration test, a reliable screening tool, employed a cut-off of < 40 for cognitive impairment. Stroop CW raw scores were age-corrected, and T-scores were obtained. Statistical analyses included correlation coefficient (r) and p-value calculations. Results: A statistically significant positive correlation (r = 0.55, p = 0.009) between Memory Alteration and Stroop CW scores was observed. Subgroup analysis confirmed the hypothesis, revealing a consistent correlation pattern for those scoring below (mean Memory Alteration 37.86±0.55, Stroop CW 48.43±2.32, r = 0.88, p = 0.009) and above (mean Memory Alteration 44.93±0.85, Stroop CW 50.79±1.89, r = 0.67, p = 0.009) the normal Memory Alteration cut-off of 40. Conclusions: The study supports the predictive ability of the Memory Alteration test on Stroop CW performance in cognitively healthy adults. It underscores the clinical relevance of the Memory Alteration test as a reliable screening tool for early cognitive impairment and processing speed changes. Clinicians are encouraged to become familiar with the Memory Alteration test, considering its inclusion as an additional cognitive screening tool. By adding this brief and non-invasive assessment into routine practice, healthcare professionals can enhance their ability to identify subtle cognitive changes early on, facilitating proactive interventions and contributing to improved patient outcomes. Limitations include sample size and variability, suggesting the need for larger, more diverse samples in future research. The ongoing Self-Management Program for Brain Health presents an opportunity to address these limitations and advance our understanding of cognitive assessment and brain health.Item Assessing the Utility of the Project ECHO Platform in Advancing the Knowledge, Skills and Abilities of the Healthcare Workforce to Improve the Health of Older Adults(2022) Ausman, Jessie; Jose, Roslin; Severance, Jennifer; Luk-Jones, Susanna; Ross, SarahPurpose: The population of older adults aged 65+ years is expected to increase by 262.9% from 2010 to 2050, thus significantly straining the geriatric care and long-term care (LTC) workforces. In addition to this, the COVID-19 pandemic has exacerbated existing strains placed on these workforces. To address these issues, the University of North Texas Health Science Center (UNTHSC) Center for Older Adults partnered with the Extension for Community Health Outcomes (ECHO) Institute to develop training and education for the LTC and geriatric care workforces. Methods: UNTHSC hosted weekly Nursing Home STRONG (NHS) ECHO training sessions targeted to LTC staff and bi-weekly Geriatrics ECHO training sessions targeted to geriatric providers. Virtually delivered NHS sessions featured specialist-led didactic presentations followed by interactive breakout discussions surrounding dementia care, IPC, workforce considerations, quality improvement, and age-friendly healthcare. Geriatric ECHO sessions followed a slightly different format; specialist-led didactic presentations were generally shorter with more time devoted to case study discussions. Topics covered during the Geriatric ECHO sessions included various aspects of dementia and cognitive impairment. Participants in both the NHS and Geriatric ECHO programs completed post-session surveys to track changes in knowledge, skills, and abilities using a five-point Likert scale. NHS participants completed a single post-session survey, while Geriatric ECHO participants completed bi-weekly surveys following the completion of each didactic session. Results: Between September 2021 and November 2021, 54 unique attendees representing 35 LTC organizations from 20 counties participated in NHS ECHO sessions. Importantly, 9 of the counties (45%) reached by the NHS ECHO were rural. A total of nine, 1-hour sessions were presented with an average of 17 attendees (excluding staff/facilitators), primarily including administrators (29.6%) and nurses (29.6%). Post-session respondents (n=10) "strongly agreed" that their knowledge of approaches to meet resident healthcare needs improved (90%), their knowledge of IPC improved (80%), and their ability to care for residents improved (80%) after attending at least one session. During this same time-period, 48 unique attendees representing 21 organizations participated in Geriatric ECHO sessions. A total of four, 1-hour sessions were presented with an average of 12 attendees, primarily including physicians (35.4%) and nurses (12.5%). Post-session responses indicated that majority of respondents "strongly agreed" that the session provided practical suggestions that can be applied in their practice (66.7 - 84.2%), the didactic topic was relevant to their learning needs (74.1 - 86.4%), and the case discussion was relevant to their learning needs (70.4 - 86.4%). Conclusions: Amidst various factors that increase burden on the healthcare workforce, the Project ECHO model offers an innovative virtual platform to adequately prepare diverse healthcare workforces to care for an aging population. This model has strong potential to improve future healthcare training and quality especially due to two unique features; collaborative, discussion-based instruction and the capacity to reach diverse and rural populations. Post-session survey responses suggested that the knowledge, attitudes, and skills of ECHO participants were improved via attendance in the NHS and/or Geriatric ECHO sessions.Item Effects on Stroop performance pre-and post-participation in the self management brain health coaching program(2022) Kannan, Srijaa; Ross, Sarah; Quiceno, Mary; Severance, Jennifer; Jose, Roslin; Clark, EmilyPurpose: About ¼ of adults age 65 and older develop cognitive impairment without dementia. Of those who live past 85, 1/3 will develop some form of dementia. Currently, there is no cure for dementia. While developing dementia may eventually be unavoidable, various factors contribute to the onset of dementia including lifestyle choices. Modifiable risk factors related to lifestyle can be addressed through health coaching. The purpose of this study is to implement a program that supports participants in making lifestyle changes that will help them function optimally now, and promote brain health and cognitive functioning in the future to help reduce their risk of developing dementia. Methods: This is a longitudinal study design in which participants are measured multiple times throughout their participation. Health coaching, education, and targeted assessments with feedback are used to provide a personalized approach to addressing brain health. Program participants received in-person health coaching across a 3-month period. Study participants must be ≥18 years of age, with no dementia or uncontrolled psychiatric illness. Participants complete survey assessments for each of the seven pillars of Brain Health: Diet, Exercise, Social Engagement, Cognitive Activity, Sleep, Mindfulness & Outlook, and General Health. Additional information collected includes demographic information and assessments of cognition. The Stroop test is a cognitive assessment that measures attention, executive functioning, and processing speed. The Stroop test was performed prior to the start and upon completion of the program; pre and post participation results were evaluated for correlations. Results: Of the 36 participants who enrolled and completed the pre-surveys for the program, 25 progressed to participate in health coaching visits with personalized brain health lifestyle goals. The average age of participants is 76. 80% of the participants are female and 94% are Caucasian. The majority of participants chose improving cognitive activity as their area of focus. Feedback from those who completed the program has been positive. Participants stated that the program length met their need for implementing change, they would recommend the program to others, and they had positive experiences with the health coach. All participants who have completed the program to date have shown an improvement in the Stroop Test raw scores for words and colors comparing the initial intake visit to the closure visit. 50% of participants showed some improvement in the color-word raw scores. Conclusion: Participants in the self-management program for brain health show improvements in attention, executive functioning, and processing speed as measured by their performance on the Stroop test. As individuals make improvements in the seven pillars of brain health, they can expect optimization of cognitive functioning and risk reduction for developing dementia. The program allows individuals to focus on the areas of most importance to them, which contributes to their success. Recommendations for future studies includes tracking participants longitudinally with an aim to assess program benefit in preventing and delaying the onset of dementia.Item Evaluation of Team STEPPS training in Skilled Nursing Facilities(2019-03-05) Ross, Sarah; Severance, Jennifer; Agena, Valerie; Oderberg, Jane; Sang, NancyPurpose Skilled nursing facilities (SNF) face many challenges in providing safe and competent care to a frail population. Surveys of SNF staff reveal poorer levels of safety culture compared to their hospital counterparts. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based interprofessional training program designed to teach tool to promote teamwork, communication, and patient safety. Implementation of TeamSTEPPS has led to improvements in patient safety culture in hospital settings, but there is a lack of evidence of benefit of TeamSTEPPS in SNF. Method Our research team adapted the TeamSTEPPS curriculum for implementation at two area SNF. We conducted three TeamSTEPPS training sessions to direct care staff (n=139). The trainings were delivered between October 2017 and June 2018. Focus group sessions comprised of the direct care staff (n=119) were then conducted at each facility between August and September 2018. The questions asked focused on staff perception on using communication tools, the training program itself, and feedback on program improvements. The comments from each of the sessions were than categorized to overarching themes. Results Thematic analysis of responses resulted in six major themes, communication, accountability, leadership/authority, implementation of the training, need for training and burn out. A majority of the comments from both facilities focused on the implementation of the training, communication, and accountability. Staff comments about the training implementation were positive and that they enjoyed the delivery method of the training and were able to apply the training to practice. Staff acknowledged that the communication tool led to improvements in communication between the staff from different shifts. Staff members also noted that they became more aware of their own roles and accountability to patient safety. Conclusion TeamSTEPPS training was well received by the direct care staff, and there were reports of improved communication and safety awareness. We anticipate that as direct care staff at SNF use TeamSTEPPS tools a positive impact will be seen on patient safety culture. Considerations for implementation of TeamSTEPPS tools in SNF requires a tailored approach. Barriers to success include high turnover in both leadership and direct care staff.Item Implementation of TeamSTEPPS For Patient Safety In Long Term Care Settings(2017-03-14) Severance, Jennifer; Ross, SarahPurpose: Patient safety is a recognized component to reducing hospital readmissions and preventable adverse events, although little is known about improving patient safety in skilled nursing settings that have an increasingly frailer and more dependent patient population due to shorter inpatient hospital stays. With a long term goal of improving the safety and quality of care provided to skilled nursing facilities (SNF), the University of North Texas Health Science Centers’ Center for Geriatrics will use a case study method to evaluate factors related to the implementation of a patient safety improvement intervention in SNF. Methods: The research team will review SNF data from secondary data sources reporting on CMS quality measures over a twelve month period to assess facility characteristics and facility performance and patient outcomes against national benchmarks. The research team will develop and implement the TeamSTEPPS Long Term Care program at the two SNF in Fort Worth, Texas, with each case defined as an individual facility. The research team will work with SNF leadership, including the Medical Director, Director of Nursing, and a licensed administrator. Implementation will occur in three phases outlined by the TeamSTEPPS program: Phase 1) conduct the patient safety culture assessment using the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Survey; Phase 2) develop performance goals and an action plan of delivering customized training on patient safety areas prioritized through the data review and patient safety culture assessment; and Phase 3) conduct patient safety training and monitor performance of action plan items. Research team members will conduct open-ended and structured interviews with facility staff to gather data on their opinions about processes and facts related to implementation. The research team will also document activities in each phase of implementation. This exploratory data will be combined with process measures established during the action plan phase to conduct a holistic investigation of the implementation processes. Results: Research will be conducted at Trinity Terrace and Brookdale Cityview skilled nursing facilities in Fort Worth, Texas. Quality improvement teams will be formed at each center to complete the TeamSTEPPS training and monitor the implementation of patient safety initiatives that increase the capacity of skilled nursing facilities to implement team approaches in quality improvement activities, and increase the ability of skilled nursing facilities to improve patient safety. Conclusions: This exploration of TeamSTEPPS implementation will develop a replicable model of implementation to improve patient safety in SNF that will improve the health status of skilled nursing facility patients.Item Intermittent hypoxia training: novel intervention for treating mild cognitive impairment(2019-03-05) Wang, Hong; Schenck, Hannah; Hall, James; Ross, Sarah; Kline, Geoffrey; Chen, Shande; Mallet, Robert T.; Shi, XiangrongPurpose: Although intermittent hypoxic training (IHT) has proven effective against various clinical disorders, its impact on mild cognitive impairment (MCI) is unknown. This study was to test if IHT was safe as a novel intervention for treating patients with MCI. Methods: MCI patients (age 69±3) alternately breathed 10% O2 and room-air (each 5 min) for 8 cycles/session, 3 sessions/week for 8 weeks. Before and after IHT, mean arterial pressure (MAP), arterial-O2 saturation (SaO2), cerebral tissue oxygenation (ScO2) and middle cerebral artery flow velocity (VMCA) were assessed, and cognitive performance was tested by mini-mental status exam (MMSE), California verbal learning test-II (CVLT-II), digit span, trail making test-B (TMT-B), and controlled oral word association test (COWAT). Results: Resting MAP fell from 101±3 to 95±3 mmHg (P2increased from 67.9±1.2 to 70.7±1.6% (PMCA(pre vs post: 46.8±3.0 vs 44.2±1.9 cm/s, P=0.21). During the 5th min of hypoxic challenge, SaO2 similarly fell to 70.3±2.9 and 73.8±1.4% pre- and post-IHT, respectively. The hypoxia-induced VMCA increase doubled from 4.5±2.2 before to 9.2±1.8 cm/s after IHT (P2 during 5-min hypoxia remained greater post- vspre-IHT (P Conclusions: IHT can be safely applied to enhance ScO2 and cerebral vasodilation during hypoxia, and potentially to improve short-term memory and concentration ability in MCI patients.Item PATIENT SAFETY CULTURE IN SKILLED NURSING FACILITIES(2018-03-14) Oderberg, Jane; Severance, Jennifer; Agena, Valerie; Ross, SarahPURPOSE Skilled nursing facilities (SNF) have an increasingly frailer and more dependent patient population with a high risk of re-hospitalization from preventable adverse events. Developing a culture of safety is a core component to clinician and staff behaviors that affect safety, quality, and patient outcomes, although little is known about improving patient safety in long term care settings. With a goal of improving the safety culture and quality of care provided in SNF settings, UNTHSC Center for Geriatrics developed and implemented the evidence-based interprofessional Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to address falls risk reduction at skilled nursing facilities in Fort Worth, Texas. METHODS We administered the Agency for Healthcare Research and Quality (AHRQ) Nursing Home Survey on Patient Safety Culture Brookdale Broadway Plaza (n=36), the Stayton (n=26) between August and October 2017. Survey results across twelve composites of patient safety culture were used to inform the development and delivery of a TeamSTEPPS Long Term Care 2.0 training series focused on falls risk reduction. The first training session delivered in October 2017 for direct care staff (n=47) provided an overview of the TeamSTEPPS model and communication tools, and an introduction to falls risk reduction in long term care settings. A second session for direct care staff (n=37) delivered in December and January provided additional training in TeamSTEPPS strategies and development of a communication tool to aid in fall risk reduction. Initial evaluation of knowledge and skills of trainees included a Likert scale survey. RESULTS Survey analysis identified that most staff believed their residents were safe in their facility (89% Brookdale,91% Stayton,82%Trinity) and they would recommend their facility to others (76% Brookdale; 80% Stayton). The lack of communication regarding residents (Brookdale 60%; Stayton 48%) was prevalent in both facilities and most direct care staff felt they were not considered members of the care team (61% Brookdale; 50% Stayton). Initial evaluation of TeamSTEPPS training showed that a majority (92-100%) were highly confident they could describe objectives related to the TeamSTEPPS program and falls awareness and prevention. As a result of the training, an action plan and communication tool was developed with input from the trainees to ensure continuity of care, improve communication, and decrease falls. Using a Plan-Do-Study-Act continuous improvement cycle, this checklist will be implemented by designated facility personnel. A post evaluation using the patient safety culture survey will be administered. CONCLUSIONS The implementation of TeamSTEPPS at SNF facilities demonstrated benefits to staff in improving their quality of care and ability to work collaboratively for the good of the patients. We anticipate that SNF will utilize TeamSTEPPS principles to develop, implement and sustain effective patient safety interventions.Item Practice Effect and Cardiorespiratory Response to Cognitive Test-Retest with Aging(2022) Reddy, Priyanka; Abdali, Kulsum; Ross, Sarah; Davis, Sandra; Shi, XiangrongBackground: This study aimed to examine the age-related difference in practice effect on cognitive performance and cardiorespiratory frequencies during test and retest with the same materials in different cognitive domains. Methods: Twenty cognitively normal older and younger men and women (65±2 vs 26±1 years old) provided the informed consent (approved by IRB) and participated in cognitive test and retest using Mini-Mental State Examination (MMSE), Digit-Span, Trail Making Test (TMT-B), and California Verbal Learning Test (CVLT-II) with ~3 weeks apart. During the testing, heart rate (HR) and breathing frequency (BF) were continuously monitored from electrocardiogram and plethysmograph. ANOVA was applied to examine the significance of the age and retest factors. Results: All cognitive performances were not affected by the age factor or the retest factor except CVLT-II. Baseline cognitive performances of the older vs younger groups were 27.7±1.1 vs 30.5±0.7 (P=0.034) in CVLT-II total Free-Recall, 29.2±0.4 vs 29.6±0.2 in MMSE, 15.6±1.6 vs 16.7±1.2 in Digit-Span, and 58.8±6.4 vs 48.0±3.6 in TMT-B, respectively. The retest factor only significantly improved total Free-Recall in the younger group (P=0.002). Baseline HR and BF were not different between the two groups, older vs younger: 72±5 vs 80±3 beats/min and 17±1 vs 16±1 breaths/min. Both HR and BF were significantly augmented (P< 0.01) in response to the cognitive test. However, both these responses were significantly attenuated during the retest (the retest factor P< 0.01). Only HR, not BF response was significantly affected by the age factor. Conclusions: There was no practice effect on cognitive performances in MMSE, Digit-Span, and TMT-B in both older and younger subjects. Total Free-Recall was significantly improved in the younger subjects only during the retest. There was a practice effect on the cardiorespiratory responses to cognitive challenge, which were significantly reduced during the cognitive retest. Aging significantly diminished HR response during cognitive challenge.Item Self-Management Program for Brain Health(2021) Jose, Roslin; Kannan, Srijaa; Ross, Sarah; Quiceno, Mary; Severance, JenniferPurpose: While developing dementia may be unavoidable, various factors contribute to its onset including lifestyle choices. The purpose of this study is to implement a program supporting lifestyle changes to improve brain health and cognitive functioning with hopes of preventing or delaying dementia. Methods: Health coaching, education and targeted assessments with feedback will be used to provide a personalized approach to addressing brain health. Inclusion criteria: ≥ 18 years old without dementia or uncontrolled psychiatric illness. Participants can choose to receive health coaching through a digital tool or in-person. They will complete assessments for each of the pillars of Brain Health: Diet, Exercise, Social Engagement, Cognitive Activity, Sleep, Mindfulness & Outlook, and General Health. Demographics, motivation to change and cognitive status will also be assessed. Health coaching will last 3 months with assessments for the pillars given 3 months before starting, at the start, at the end, and 3 months after completion. We will evaluate scores for each assessment at various points in time for improvement or other trends. Results: This program is in the beginning stages of implementation. Conclusion: This self-management program intends to promote lifestyle changes that will reduce the risk of developing dementia. If individuals make improvements in the seven pillars, they can expect optimization of cognitive functioning and risk reduction for developing dementia. Clinical implications include the development of an evidence-based program for addressing risk factors for dementia with potential for preventing or delaying its onset.Item SLOW RECOVERY OF CEREBRAL PERFUSION DURING HYPOTENSION IN ELDERLY HUMANS(2021) Abdali, Kulsum; Chen, Xiaoan; Cai, Ming; Ross, Sarah; Davis, Sandra; Zhou, Zhengyang; Shi, XiangrongPurpose: Aging affects the cardiovascular function. This study tested the hypothesis that aging diminishes cerebral perfusion during hypotension challenge. Methods: Healthy elderly (n=13) and young (n=13) adults signed a consent form that was approved by IRB at UNTHSC. Heart rate (HR), mean arterial pressure (MAP), and cerebral blood flow velocity of the middle cerebral artery (VMCA) were continuously measured during systemic hypotension, which was induced by rapid-deflation of bilateral thigh-cuffs after 3-min supra-systolic occlusion. This hypotension elicited a transient-decrease in VMCA (ΔVMCA) and a reflexive-increase in HR (ΔHR). Time duration reaching the nadir of MAP and VMCA (T0) and the rate of the recovery response (TR) were compared between the groups. Results: Cuff deflation after occlusion to the legs significantly decreased MAP (ΔMAP) which elicited significant hypoperfusion to the brain in both groups. Although ΔMAP and ΔVMCA were not statistically different between the groups, both T0 and TR for MAP and VMCA were significantly longer in the elderly group. T0 and TR were shorter for ΔVMCA than ΔMAP, suggesting the presence of cerebral autoregulation, which evoked an early recovery of ΔVMCA from its nadir, and also explained an early completion of VMCA recovery before MAP restoration. In addition, the rates of ΔMAP and ΔHR during recovery were diminished with aging, which explained a prolonged recovery of cerebral perfusion. Conclusion: We conclude that aging diminishes the function of maintaining cerebral perfusion during hypotension, which is associated with age-impaired cerebral intrinsic factor and systemic function.Item Strategies for Promotion of a Patient Portal in the UNT Geriatrics Clinic for Improved Satisfaction and Access(2017-03-14) Loza, Cynthia; Henderson, Leslie; Booker, Sandra; Prasad, Subhada; Ross, SarahPurpose: The use of electronic health records has become a vital part of patient care. Electronic health records have many benefits, including assisting providers with tracking tasks important for health maintenance and chronic disease management. Electronic health records also have patient portals, which are secure online websites that give patients access to their personal health information. NexGen is the electronic health records system used at the University of North Texas Health Sciences Center, and we have recently started using their Patient Portal. Our team has worked on promotion and training in the patient portal to assist with participation by both clinical staff and patients. The goal is improve patient and caregiver access to their personal health information, improved satisfaction, and improved communication with their care team. Additionally, the patient portal will support improved chronic disease management by providing a way to send electronic messages to patients with reminders of any necessary testing or notifications of any educational programs relevant to their condition. In the Geriatric population, we want to make use of a patient portal user friendly for those with low computer literacy and also usable by caregivers of patients with cognitive impairments. Methods: The team has used several tools for promotion of the patient portal. A video was produced to train staff on how to enroll patients in the portal and how view messages receive through the portal. A kiosk was set up in the waiting room of the UNT Geriatrics clinic with student volunteers to assist patients one-on-one with enrollment. Buttons for advertisement and awareness were distributed to office staff. We also created an icon in NexGen to easily recognize which patients have already enrolled. When the goal of 60% enrollment is achieved, the team plans to evaluate outcomes of improved access and satisfaction. Both a general and a patient portal specific patient satisfaction survey will be distributed to the UNT Geriatrics patients. We will also compare communication received from patients by phone which electronic communication through the patient portal. Results/Conclusions: Enrollment in the NexGen patient portal in the UNT Geriatrics clinic is on the rise. Patients who are participating have enjoyed the ability to email their care team with questions. In particular, we have had success in providing improved access for our hearing impaired patient, as the Geriatrics office staff have emailed for coordination of acute appointments to address urgent needs. As more patients and caregivers utilize this tool we hope to show improved patient satisfaction. Regarding access to the care team, we anticipate a slight decrease in phone calls with more use of the patient portal for electronic communication. Adjustments to the patient portal will be made over time to ensure that it is patient centered and providing patients and caregivers with the information they need to manage their health.Item The Influence of Acculturation and Psychosocial Factors on Glycemic Control in Mexicans and Mexican Americans with Type II Diabetes(2007-04-01) Ross, Sarah; Luz Chiapa, Ana; Cardarelli, Roberto; Sanders, MarkRoss, Sarah., The Influence of Acculturation and Psychosocial Factors on Glycemic Control in Mexicans and Mexican Americans with Type II Diabetes. Master of Science (Biomedical Sciences), April, 2007, 51 pp., 5 tables, 1 figure, bibliography. Type 2 diabetes is prevalent among Mexican Americans. Tight glycemic control helps delay diabetic complications. This project aims to identify characteristics that contribute to poor glycemic control in this population. Mexican/Mexican American type 2 diabetics completed questionnaires measuring acculturation and psychosocial factors. This data was analyzed to assess the relationship of the factors and glycemic control as measured by HemoglobinA1C. Results demonstrated that subjects who felt that diabetes interfered with daily life and were dissatisfied with their physician’s answers to diabetes questions had poor glycemic control. Significant differences between acculturation groups’ responses to psychosocial measures were also found. Further studies may more accurately define the influence of acculturation on glycemic control in this population.